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Hetherton A, Horgan F, Sorensen J, Mc Carthy SE. Contextual factors and intentional rounding in acute hospitals: understanding what works, for whom, in what settings: a realist synthesis protocol. HRB Open Res 2024; 6:72. [PMID: 38989100 PMCID: PMC11234086 DOI: 10.12688/hrbopenres.13792.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
Background This study aims to understand and explain the influence of contextual factors on the implementation of Intentional Rounding in acute hospitals using the realist synthesis methodology.Falls of hospital admitted patients are one of the most frequent concerns for patient safety in the acute hospital environment. The reasons why people fall are complex. International guidelines recommend a multifactorial assessment and effective prevention and management of identified risk factors in order to reduce the number of falls. Intentional Rounding (IR) is one approach for delivering this. IR is an umbrella term, understood as a structured process whereby nurses or care staff carry out regular checks with individual patients using a standardised protocol to address such issues as positioning, pain, personal needs and placement of possessions. Methods This study will use realist synthesis to understand what works, for whom, in what circumstances, and in what settings. Realist synthesis is a theory driven interpretive approach to evidence synthesis. It is our intention to analyse IR as an intervention, which aims to enhance patient care and safety in hospital settings. The synthesis forms part of a larger implementation study examining interventions that reduce the number of falls that occur in hospitals. Search terms will include intentional rounding, purposeful rounding, comfort rounding and hourly rounding and will encompass search terms beyond IR and falls rates to avoid limiting the synthesis. This synthesis will conform to the RAMESES (realist and meta-narrative evidence synthesis group) publication and reporting quality standards. Conclusions The findings will inform the next phase of an implementation study on IR in acute hospital settings, to address evidence informed enablers and barriers to IR. The results will be disseminated in a peer-reviewed journal and through presentations.
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Affiliation(s)
- Aileen Hetherton
- School of Postgraduate Studies, Royal College of Surgeons in Ireland, RCSI University of Medicine and Health Sciences, Dublin, Leinster, D02 YN77, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, RCSI University of Medicine and Health Sciences, Dublin, Leinster, D02 YN77, Ireland
| | - Jan Sorensen
- Health Outcomes Research Centre, Royal College of Surgeons in Ireland, RCSI University of Medicine and Health Sciences, Dublin, Leinster, D02 YN77, Ireland
| | - Siobhan E Mc Carthy
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, RCSI University of Medicine and Health Sciences, Dublin, Leinster, D02 YN77, Ireland
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Henderson R, McInnes A, Danyluk A, Wadsworth I, Healy B, Crowshoe L. A realist review of best practices and contextual factors enhancing treatment of opioid dependence in Indigenous contexts. Harm Reduct J 2023; 20:34. [PMID: 36932417 PMCID: PMC10022548 DOI: 10.1186/s12954-023-00740-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/19/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES The objective of this study was to examine international literature to identify best practices for treatment of opioid dependence in Indigenous contexts. METHODS We utilized a systematic search to identify relevant literature. The literature was analysed using a realist review methodology supported by a two-step knowledge contextualization process, including a Knowledge Holders Gathering to initiate the literature search and analysis, and five consensus-building meetings to focus and synthesize relevant findings. A realist review methodology incorporates an analysis of the complex contextual factors in treatment by identifying program mechanisms, namely how and why different programs are effective in different contexts. RESULTS A total of 27 sources were identified that met inclusion criteria. Contextual factors contributing to opioid dependence described in the literature often included discussions of a complex interaction of social determinants of health in the sampled community. Twenty-four articles provided evidence of the importance of compassion in treatment. Compassion was evidenced primarily at the individual level, in interpersonal relationships based on nonjudgmental care and respect for the client, as well as in more holistic treatment programs beyond biophysical supports such as medically assisted treatment. Compassion was also shown to be important at the structural level in harm reduction policies. Twenty-five articles provided evidence of the importance of client self-determination in treatment programs. Client self-determination was evidenced primarily at the structural level, in community-based programs and collaborative partnerships based in trust and meaningful engagement but was also shown to be important at the individual level in client-directed care. Identified outcomes moved beyond a reduction in opioid use to include holistic health and wellness goals, such as improved life skills, self-esteem, feelings of safety, and healing at the individual level. Community-level outcomes were also identified, including more families kept intact, reduction in drug-related medical evacuations, criminal charges and child protection cases, and an increase in school attendance, cleanliness, and community spirit. CONCLUSIONS The findings from this realist review indicate compassion and self-determination as key program mechanisms that can support outcomes beyond reduced incidence of substance use to include mitigating systemic health inequities and addressing social determinants of health in Indigenous communities, ultimately healing the whole human being.
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Affiliation(s)
- Rita Henderson
- University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Ashley McInnes
- University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Ava Danyluk
- University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | | | - Bonnie Healy
- , Blood Tribe, AB, Canada
- Blackfoot Confederacy, Calgary, AB, T2H 2G5, Canada
| | - Lindsay Crowshoe
- University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
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A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries. Soc Sci Med 2020; 270:113624. [PMID: 33373774 DOI: 10.1016/j.socscimed.2020.113624] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/08/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022]
Abstract
Pay for performance (P4P) programmes are popular health system-focused interventions aiming to improve health outcomes in low-and middle-income countries (LMICs). This realist review aims to understand how, why and under what circumstance P4P works in LMICs.We systematically searched peer-reviewed and grey literature databases, and examined the mechanisms underpinning P4P effects on: utilisation of services, patient satisfaction, provider productivity and broader health system, and contextual factors moderating these. This evidence was then used to construct a causal loop diagram.We included 112 records (19 grey literature; 93 peer-reviewed articles) assessing P4P schemes in 36 countries. Although we found mixed evidence of P4P's effects on identified outcomes, common pathways to improved outcomes include: community outreach; adherence to clinical guidelines, patient-provider interactions, patient trust, facility improvements, access to drugs and equipment, facility autonomy, and lower user fees. Contextual factors shaping the system response to P4P include: degree of facility autonomy, efficiency of banking, role of user charges in financing public services; staffing levels; staff training and motivation, quality of facility infrastructure and community social norms. Programme design features supporting or impeding health system effects of P4P included: scope of incentivised indicators, fairness and reach of incentives, timely payments and a supportive, robust verification system that does not overburden staff. Facility bonuses are a key element of P4P, but rely on provider autonomy for maximum effect. If health system inputs are vastly underperforming pre-P4P, they are unlikely to improve only due to P4P. This is the first realist review describing how and why P4P initiatives work (or fail) in different LMIC contexts by exploring the underlying mechanisms and contextual and programme design moderators. Future studies should systematically examine health system pathways to outcomes for P4P and other health system strengthening initiatives, and offer more understanding of how programme design shapes mechanisms and effects.
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Gamache S, Diallo TA, Shankardass K, Lebel A. The Elaboration of an Intersectoral Partnership to Perform Health Impact Assessment in Urban Planning: The Experience of Quebec City (Canada). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7556. [PMID: 33080815 PMCID: PMC7588892 DOI: 10.3390/ijerph17207556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
Health impact assessments (HIA) allow evaluation of urban interventions' potential effects on health and facilitate decision-making in the urban planning process. However, few municipalities have implemented this method in Canada. This paper presents the approach developed with partners, the process, and the outcomes of HIA implementation after seven years of interinstitutional collaborations in Quebec City (ten HIA). Using direct observation and meeting minutes, information includes: perceived role of each institution taking part in HIA beforehand, how the HIA process was implemented, if it was appreciated, and which outcomes were observed. The intersectoral interactions contributed to the development of a common language, which sped up the HIA process over time and fostered positive collaborations in unrelated projects. It was an effective tool to share concerns and responsibilities among independent institutions. This experience resulted in the creation of an informal group of stakeholders from four different institutions that perform HIA to this day in collaboration with researchers.
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Affiliation(s)
- Stéphanie Gamache
- Graduate School of Land Management and Regional Planning, Faculty of Planning, Architecture, Art and Design, Laval University, Québec, QC G1V 0A6, Canada; (S.G.); (T.A.D.)
| | - Thierno Amadou Diallo
- Graduate School of Land Management and Regional Planning, Faculty of Planning, Architecture, Art and Design, Laval University, Québec, QC G1V 0A6, Canada; (S.G.); (T.A.D.)
- National Collaborating Centre for Healthy Public Policy, Montréal, QC H2P 1E2, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada;
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Alexandre Lebel
- Graduate School of Land Management and Regional Planning, Faculty of Planning, Architecture, Art and Design, Laval University, Québec, QC G1V 0A6, Canada; (S.G.); (T.A.D.)
- Quebec Heart and Lung Institute, Québec, QC G1V 4G5, Canada
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The impact of income support systems on healthcare quality and functional capacity in workers with low back pain: a realist review. Pain 2020; 161:2690-2709. [PMID: 32618874 DOI: 10.1097/j.pain.0000000000001978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Low back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers' compensation or social security. This study examines how and in what contexts income support systems impact the healthcare quality for people with work disability and LBP and their functional capacity. We performed a realist review. Five initial theories about the relationship between income support systems and outcomes were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented with gray literature searches for policy documents and semistructured interviews with experts in income support, health care, and LBP. Income support systems influence healthcare quality through funding restrictions, healthcare provider administrative burden, and allowing employers to select providers. They also influence worker functional capacity through the level of participation and financial incentives for employers, measures to prove the validity of the worker's LBP, and certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition. Research and policy design should consider how income support systems may indirectly influence workers with LBP through the workplace.
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Groot G, Waldron T, Barreno L, Cochran D, Carr T. Trust and world view in shared decision making with indigenous patients: A realist synthesis. J Eval Clin Pract 2020; 26:503-514. [PMID: 31750600 PMCID: PMC7154772 DOI: 10.1111/jep.13307] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/07/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION How shared decision making (SDM) works with indigenous patient values and preferences is not well understood. Colonization has affected indigenous peoples' levels of trust with institutions, and their world view tends to be distinct from that of nonindigenous people. Building on a programme theory for SDM, the present research aims to refine the original programme theory to understand how the mechanisms of trust and world view might work differently for indigenous patients. DESIGN We used a six-step iterative process for realist synthesis: preliminary programme theory development, search strategy development, selection and appraisal of literature, data extraction, data analysis and synthesis, and formation of a revised programme theory. DATA SOURCES Searches were through Medline, CINAHL, and the University of Saskatchewan iPortal for grey literature. Medline and CINAHL searches included the University of Alberta Canada-wide indigenous peoples search filters. DATA SYNTHESIS Following screening 731 references, 90 documents were included for data extraction (53 peer reviewed and 37 grey literature). Documents from countries with similar colonization experiences were included. RESULTS A total of 518 context-mechanism-outcome (CMO) configurations were identified and synthesized into 21 CMOs for a revised programme theory. Demographics, indigenous world view, system and institutional support, language barriers, and the macro-context of discrimination and historical abuse provided the main contexts for the programme theory. These inspired mechanisms of reciprocal respect, perception of world view acceptance, and culturally appropriate knowledge translation. In turn, these mechanisms influenced the level of trust and anxiety experienced by indigenous patients. Trust and anxiety were both mechanisms and intermediate outcomes and determined the level of engagement in SDM. CONCLUSION This realist synthesis provides clinicians and policymakers a deeper understanding of the complex configurations that influence indigenous patient engagement in SDM and offers possible avenues for improvement.
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Affiliation(s)
- Gary Groot
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Tamara Waldron
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Leonzo Barreno
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - David Cochran
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Tracey Carr
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
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Garg P, Eastwood J, Liaw ST. A Realist Synthesis of Literature Informing Programme Theories for Well Child Care in Primary Health Systems of Developed Economies. Int J Integr Care 2019; 19:5. [PMID: 31367204 PMCID: PMC6659757 DOI: 10.5334/ijic.4177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/10/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Well-child Care is the provision of preventative health care services for children and their families. The approach, however, to the universal provision of those services is contentious. METHODS We undertook a realist synthesis to enhance understanding of the theoretical mechanisms driving Well-child Care by searching for published and grey literature from multiple databases. FINDINGS Well-child Care is re-conceptualised as an integrated program delivered in the continuum of pregnancy, infancy and childhood. Depending on the context, Well-child Care can be a policy, a strategy, or an actual clinical practice that promotes child and family health. The main mechanisms include: role, training and continuity of health providers; administrators' views of the return of investment on achieved outcomes; access to services by families; and the adaptation of programs to meet the dynamic needs of stakeholders. Evidence indicates that for most outcomes, Well-child Care is best delivered in partnerships between community health, social care, and early childhood education sectors. CONCLUSIONS We conclude that Well-child Care policy and program leaders should shift their focus to the integration of: human and physical resources; policy instruments; and shared agreement on outcomes measures across health, social and education sectors. In addition, countries should work towards strengthening universal early education programs and parents' health literacy regarding child development, health and safety.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, NSW, AU
- Specialist Disability Health Team, South Western Sydney Local Health District, NSW, AU
- South Western Sydney Local Health District, NSW, AU
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Women’s and Children’s Health, University of New South Wales (UNSW), AU
| | - John Eastwood
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Women’s and Children’s Health, University of New South Wales (UNSW), AU
- School of Public Health, University of Sydney, Sydney, NSW, AU
- School of Public Health, Griffith University, Gold Coast, QLD, AU
- Department of Community Paediatrics, Sydney Local Health District, Croydon, NSW, AU
- School of Public Health and Community Medicine, UNSW, AU
| | - Siaw-Teng Liaw
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Public Health and Community Medicine, UNSW, AU
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Lawal AK, Groot G, Goodridge D, Scott S, Kinsman L. Development of a program theory for clinical pathways in hospitals: protocol for a realist review. Syst Rev 2019; 8:136. [PMID: 31176372 PMCID: PMC6556023 DOI: 10.1186/s13643-019-1046-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the increased utilization of clinical pathways (CPWs) as a strategy to improve patient and system outcomes in hospitals, there remain ongoing challenges with their conceptualization, implementation, and evaluation. Theories that explain how CPWs work in hospitals are lacking, making it difficult to identify important factors for sustaining changes arising from CPWs implemented in hospitals. The objective of this realist review is to develop a program theory for CPWs in hospitals. METHODS This is a protocol for a realist review. The review will use a six-step iterative process to develop a program theory for CPWs in hospitals: (1) development of a preliminary program theory; (2) search strategy and literature search; (3) study selection and appraisal; (4) data extraction; (5) data analysis and synthesis; and (6) stakeholder engagement. In addition to searching the gray literature and contacting authors, we will search electronic databases such as MEDLINE, NHSEED, CINAHL EBSCO, HMIC, and PsycINFO. Studies will be included based on their ability to provide data that test some aspect of the program theory. Two independent reviewers will select, screen, and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome heuristics that explains how CPWs implemented in hospitals translates to better health system outcomes. DISCUSSION Overall, the review aims to develop a program theory for CPWs in hospitals and to explore how, why, to what extent, and in what contexts does the implementation of CPWs in hospitals contribute to better health system outcomes. As a result, the review will provide a theoretical framework of how CPWs work in hospitals. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018103220.
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Affiliation(s)
- Adegboyega K Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
| | - Gary Groot
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Donna Goodridge
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Shannon Scott
- Faculty of Nursing, University of Alberta Edmonton, Edmonton, Canada
| | - Leigh Kinsman
- University of Newcastle and Mid-North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, Australia
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Di Donato M, Iles R, Lane T, Collie A. The impact of income support systems on healthcare quality and functional capacity in workers with low back pain: a realist review protocol. Syst Rev 2019; 8:92. [PMID: 30967157 PMCID: PMC6454741 DOI: 10.1186/s13643-019-1003-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/25/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Low back pain is the greatest contributor to the global burden of disease and can result in work disability. Previous literature has examined the influence of personal factors, the healthcare system, workplace, and income support systems on work disability due to low back pain. Income support systems may also influence healthcare and the workplace, leading to an impact on healthcare quality and functional capacity. However, there has been little insight as to how or in what contexts this influence occurs. This realist review aims to provide an explanation of how and in what contexts income support systems impact the healthcare quality and functional capacity of people who are unable to work due to low back pain. METHODS Realist reviews are a type of literature review that seek to determine how and in what contexts a social programme such as income support leads to an outcome, rather than simply determining whether or not it works. Five initial theories about how income support systems impact healthcare quality and functional capacity are posited in this protocol. An iterative search of electronic databases for academic literature will be used to acquire and synthesise evidence that may support or refute these initial theories. Grey literature such as policy documents will be identified to characterise income support and healthcare systems and supplement contextual details. Semi-structured interviews with income support, healthcare, and low back pain experts will also be performed to complement literature searching with anecdotal and experiential evidence. At the conclusion of the review, initial theories will be supported or refuted and refined into programme theories that will be explained by evidence in context-mechanism-outcome configurations. DISCUSSION Income support and healthcare systems are highly complex and fluid programmes. At the intersection between these systems are those with low back pain. By using realist review methods, we will provide explanatory rather than judgemental findings. The resulting multi-dimensional and contextual understanding of the impact of income support systems on important low back pain outcomes will provide valuable insight for future income support and healthcare policy development.
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Affiliation(s)
- Michael Di Donato
- Insurance Work and Health Group, Health Services Division, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000 Australia
| | - Ross Iles
- Insurance Work and Health Group, Health Services Division, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000 Australia
| | - Tyler Lane
- Insurance Work and Health Group, Health Services Division, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000 Australia
| | - Alex Collie
- Insurance Work and Health Group, Health Services Division, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000 Australia
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Tyler I, Pauly B, Wang J, Patterson T, Bourgeault I, Manson H. Evidence use in equity focused health impact assessment: a realist evaluation. BMC Public Health 2019; 19:230. [PMID: 30808317 PMCID: PMC6390302 DOI: 10.1186/s12889-019-6534-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Equity-focused health impact assessment (EFHIA) can function as a framework and tool that supports users to collate data, information, and evidence related to health equity in order to identify and mitigate the impact of a current or proposed initiative on health inequities. Despite education efforts in both the clinical and public health settings, practitioners have found implementation and the use of evidence in completing equity focussed assessment tools to be challenging. METHODS We conducted a realist evaluation of evidence use in EFHIA in three phases: 1) developing propositions informed by a literature scan, existing theoretical frameworks, and stakeholder engagement; 2) data collection at four case study sites using online surveys, semi-structured interviews, document analysis, and observation; and 3) a realist analysis and identification of context-mechanism-outcome patterns and demi-regularities. RESULTS We identified limited use of academic evidence in EFHIA with two explanatory demi-regularities: 1) participants were unable to "identify with" academic sources, acknowledging that evidence based practice and use of academic literature was valued in their organization, but seen as less likely to provide answers needed for practice and 2) use of academic evidence was not associated with a perceived "positive return on investment" of participant energy and time. However, we found that knowledge brokering at the local site can facilitate evidence familiarity and manageability, increase user confidence in using evidence, and increase the likelihood of evidence use in future work. CONCLUSIONS The findings of this study provide a realist perspective on evidence use in practice, specifically for EFHIA. These findings can inform ongoing development and refinement of various knowledge translation interventions, particularly for practitioners delivering front-line public health services.
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Affiliation(s)
| | - Bernie Pauly
- School of Nursing, Scientist, Canadian Institute for Substance Use Research, UVIC Community Engaged Scholar , University of Victoria, Victoria, BC, Canada
| | | | | | - Ivy Bourgeault
- Telfer School of Management, the University of Ottawa, Canadian Institutes of Health Research Chair in Gender, Work and Health Human Resources, Ottawa, Canada
| | - Heather Manson
- Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
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Renahy E, Mitchell C, Molnar A, Muntaner C, Ng E, Ali F, O'Campo P. Connections between unemployment insurance, poverty and health: a systematic review. Eur J Public Health 2019; 28:269-275. [PMID: 29360958 DOI: 10.1093/eurpub/ckx235] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Since the global economic crisis in 2007, unemployment rates have escalated in most European and North American countries. Unemployment protection policies, particularly the unemployment insurance (UI) system, have become a weighty issue for many modern welfare states. Decades of research have established concrete findings on the adverse impacts of unemployment on poverty- and health-related outcomes. This provided a foundation for further exploration into the potential protective effects of UI in offsetting these adverse outcomes. Methods We developed a systematic review protocol in four stages (literature search, study selection, data extraction and quality appraisal) to ensure a rigorous data collection and inter-rated reliability. We examined the full body of empirical research published between 2000 and 2013 on the pathways by which UI impacts poverty and health. Results Out of 2233 primary studies identified, a total of 12 met our inclusion criteria. The selected studies assessed poverty-related outcomes (absolute/relative poverty and material hardship) or one or more health-related outcomes (health behaviors, self-rated health, well-being and mental health). Across various UI systems, jurisdictions from high income countries, and study designs, we found good support for our conceptual framework, by which UI attenuates the effect of unemployment on both poverty and health, with a few exceptions. Conclusion Whether UI impacts differ by age and region might be explored further in future research. The complex mediating relationship between unemployment, UI, poverty and health should further be assessed in light of economic and historical contexts. This could inform decision-making processes during future periods of economic recession.
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Affiliation(s)
- Emilie Renahy
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Christiane Mitchell
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Agnes Molnar
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Edwin Ng
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Farihah Ali
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Patricia O'Campo
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Power J, Gilmore B, Vallières F, Toomey E, Mannan H, McAuliffe E. Adapting health interventions for local fit when scaling-up: a realist review protocol. BMJ Open 2019; 9:e022084. [PMID: 30679286 PMCID: PMC6347947 DOI: 10.1136/bmjopen-2018-022084] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 10/23/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Scaling-up is essential to ensure universal access of effective health interventions. Scaling-up is a complex process, which occurs across diverse systems and contexts with no one-size-fits-all approach. To date, little attention has been paid to the process of scaling-up in how to make adaptations for local fit. The aim of this research is to develop theory on what actions can be used to make adaptations to health interventions for local fit when scaling-up across diverse contexts that will have practical application for implementers involved in scaling-up. METHODS AND ANALYSIS Given the complexity of this subject, a realist review methodology was selected. Specifically, realist review emphasises an iterative, non-linear process, whereby the review is refined as it progresses. The identification of how the context may activate mechanisms to achieve outcomes is used to generate theories on what works for whom in what circumstances. This protocol will describe the first completed stage of development of an initial programme theory framework, which identified potential actions, contexts, mechanisms and outcomes that could be used to make adaptations when scaling-up. It will then outline the methods for future stages of the review which will focus on identifying case examples of scale-up and adaptation in practice. This realist review consists of six stages: (i) clarifying scope and development of a theoretical framework, (ii) developing a search strategy, (iii) selection and appraisal, (iv) data extraction, (v) data synthesis and analysis and (vi) further theory refinement with stakeholders. ETHICS AND DISSEMINATION This review will develop theory on how adaptations can be made when scaling-up. Findings will be disseminated in a peer-reviewed journal and through stakeholder engagement as part of the research process. Ethical approval has been received through Health Policy and Management/Centre for Global Health Research Ethics Committee of Trinity College Dublin.
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Affiliation(s)
- Jessica Power
- Centre for Global Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Brynne Gilmore
- Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Frédérique Vallières
- Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Hasheem Mannan
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Tyler I, Lynam J, O'Campo P, Manson H, Lynch M, Dashti B, Turner N, Feller A, Ford-Jones EL, Makin S, Loock C. It takes a village: a realist synthesis of social pediatrics program. Int J Public Health 2018; 64:691-701. [PMID: 30582136 PMCID: PMC6565657 DOI: 10.1007/s00038-018-1190-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/16/2018] [Accepted: 12/03/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To better understand how social pediatric initiatives (SPIs) enact equitable, integrated, embedded approaches with high-needs children and families while facilitating proportionate distribution of health resources. METHODS The realist review method incorporated the following steps: (1) identifying the review question, (2) formulating the initial theory, (3) searching for primary studies, (4) selecting and appraising study quality, (5) synthesizing relevant data and (6) refining the theory. RESULTS Our analysis identified four consistent patterns of care that may be effective in social pediatrics: (1) horizontal partnerships based on willingness to share status and power; (2) bridged trust initiated through previously established third party relationships; (3) knowledge support increasing providers' confidence and skills for engaging community; and (4) increasing vulnerable families' self-reliance through empowerment strategies. CONCLUSIONS This research is unique because it focused on "how" outcomes are achieved and offers insight into the knowledge, skills and philosophical orientation clinicians need to effectively deliver care in SPIs. Research insights offer guidance for organizational leaders with a mandate to address child and youth health inequities and may be applicable to other health initiatives.
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Affiliation(s)
| | - Judith Lynam
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Nicole Turner
- RD McMaster Children's Hospital, Hamilton, ON, Canada
| | - Andrea Feller
- FAAP, FACPM Niagara Region, Public Health, Thorold, ON, Canada
| | | | - Sue Makin
- Toronto Public Health (retired), Toronto, ON, Canada
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Borghi J, Singh NS, Brown G, Anselmi L, Kristensen S. Understanding for whom, why and in what circumstances payment for performance works in low and middle income countries: protocol for a realist review. BMJ Glob Health 2018; 3:e000695. [PMID: 29988988 PMCID: PMC6035508 DOI: 10.1136/bmjgh-2017-000695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/03/2018] [Accepted: 05/17/2018] [Indexed: 12/22/2022] Open
Abstract
Background Many low and middle income countries (LMIC) are implementing payment for performance (P4P) schemes to strengthen health systems and make progress towards universal health coverage. A number of systematic reviews have considered P4P effectiveness but did not explore how P4P works in different settings to improve outcomes or shed light on pathways or mechanisms of programme effect. This research will undertake a realist review to investigate how, why and in what circumstances P4P leads to intended and unintended outcomes in LMIC. Methods Our search was guided by an initial programme theory of mechanisms and involved a systematic search of Medline, Embase, Popline, Business Source Premier, Emerald Insight and EconLit databases for studies on P4P and health in LMIC. Inclusion and exclusion criteria identify literature that is relevant to the initial programme theory and the research questions underpinning the review. Retained evidence will be used to test, revise or refine the programme theory and identify knowledge gaps. The evidence will be interrogated by examining the relationship between context, mechanisms and intended and unintended outcomes to establish what works for who, in which contexts and why. Discussion By synthesising current knowledge on how P4P affects health systems to produce outcomes in different contexts and to what extent the programme design affects this, we will inform more effective P4P programmes to strengthen health systems and achieve sustainable service delivery and health impacts.
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Affiliation(s)
- Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Garrett Brown
- School of Politics and International Studies, University of Leeds, Leeds, UK
| | - Laura Anselmi
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Soren Kristensen
- Faculty of Medicine, Institute of Global Health Innovation, Centre for Health Policy, Imperial College, London, UK
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Son KB, Kim CY, Lee TJ. Understanding of for whom, under what conditions and how the compulsory licensing of pharmaceuticals works in Brazil and Thailand: A realist synthesis. Glob Public Health 2018; 14:122-134. [PMID: 29734843 DOI: 10.1080/17441692.2018.1471613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
When pharmaceuticals are not fully available mainly due to the high cost of medicines, a government can issue compulsory licensing (CL). It is well documented that Brazil and Thailand have notably attempted CL. A realist review was undertaken to understand the identical social interventions in comparative settings, and to draw practical implications for attempting CL relevant for middle-income countries in the era of high-cost medicines. CL is not only a politically well-devised measure to achieve universal health coverage, but also a tentative commitment, which is determined both at the country level and at the global level. At the country level, political will, with catalytic roles of civil activism, is important in order to guarantee the right to health. Through this will, the governments can achieve universal health coverage. In addition, electoral systems, political leaders, and a constitution are necessary to attempt CL. In addition, CL should operate along with other policy instruments, including a comprehensive essential medicines list, CL-friendly phrasing in patent law, and a competent pharmaceutical industry. At the global level, the balance of power between the WTO regime and the global justice movement is critical. This provides global-level context that can either encourage or prevent CL.
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Affiliation(s)
- Kyung-Bok Son
- a College of Pharmacy , Ewha Womans University , Seoul , South Korea.,b Institute of Health and Environment , Seoul National University , Seoul , South Korea
| | - Chang-Yup Kim
- b Institute of Health and Environment , Seoul National University , Seoul , South Korea.,c Department of Health Care Management and Policy , Graduate School of Public Health, Seoul National University , Seoul , South Korea
| | - Tae-Jin Lee
- b Institute of Health and Environment , Seoul National University , Seoul , South Korea.,d Department of Public Health Science , Graduate School of Public Health, Seoul National University , Seoul , South Korea
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Muntaner C, Mahabir DF. Just Say No to the TPP: A Democratic Setback for American and Asian Public Health Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?". Int J Health Policy Manag 2017; 6:419-421. [PMID: 28812839 PMCID: PMC5505113 DOI: 10.15171/ijhpm.2016.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/31/2016] [Indexed: 11/20/2022] Open
Abstract
The article by Labonté, Schram, and Ruckert is a significant and timely analysis of the Trans-Pacific Partnership (TPP) policy and the severe threats to public health that it implies for 12 Pacific Rim populations from the Americas and Asia (Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, United States, and Vietnam). With careful and analytic precision the authors convincingly unearth many aspects of this piece of legislation that undermine the public health achievements of most countries involved in the TTP. Our comments complement their policy analysis with the aim of providing a positive heuristic tool to assist in the understanding of the TPP, and other upcoming treaties like the even more encompassing Transatlantic Trade and Investment Partnership (TTIP), and in so doing motivate the public health community to oppose the implementation of the relevant provisions of the agreements. The aims of this commentary on the study of Labonté et al are to show that an understanding of the health effects of the TPP is incomplete without a political analysis of policy formation, and that realist methods can be useful to uncover the mechanisms underlying TPP’s political and policy processes.
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Affiliation(s)
- Carles Muntaner
- Bloomberg Faculty of Nursing University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Deb Finn Mahabir
- Bloomberg Faculty of Nursing University of Toronto, Toronto, ON, Canada
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Groot G, Waldron T, Carr T, McMullen L, Bandura LA, Neufeld SM, Duncan V. Development of a program theory for shared decision-making: a realist review protocol. Syst Rev 2017; 6:114. [PMID: 28623941 PMCID: PMC5474020 DOI: 10.1186/s13643-017-0508-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/31/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The practicality of applying evidence to healthcare systems with the aim of implementing change is an ongoing challenge for practitioners, policy makers, and academics. Shared decision- making (SDM), a method of medical decision-making that allows a balanced relationship between patients, physicians, and other key players in the medical decision process, is purported to improve patient and system outcomes. Despite the oft-mentioned benefits, there are gaps in the current literature between theory and implementation that would benefit from a realist approach given the value of this methodology to analyze complex interventions. In this protocol, we outline a study that will explore: "In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved decision making?" METHODS A seven step iterative process will be described including preliminary theory development, establishment of a search strategy, selection and appraisal of literature, data extraction, analysis and synthesis of extracted results from literature, and formation of a revised program theory with the input of patients, physicians, nurse navigators, and policy makers from a stakeholder session. DISCUSSION The goal of the realist review will be to identify and refine a program theory for SDM through the identification of mechanisms which shape the characteristics of when, how, and why SDM will, and will not, work. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017062609.
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Affiliation(s)
- Gary Groot
- Department of Community Health and Epidemiology, Health Sciences Building, University of Saskatchewan College of Medicine, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Tamara Waldron
- Department of Community Health and Epidemiology, Health Sciences Building, University of Saskatchewan College of Medicine, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, Health Sciences Building, University of Saskatchewan College of Medicine, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Linda McMullen
- Department of Psychology, College of Arts and Sciences, University of Saskatchewan Arts 154, 9 Campus Drive, Saskatoon, SK S7N 5A5 Canada
| | | | - Shelley-May Neufeld
- Department of Community Health and Epidemiology, Health Sciences Building, University of Saskatchewan College of Medicine, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Vicky Duncan
- Department of Community Health and Epidemiology, Health Sciences Building, University of Saskatchewan College of Medicine, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
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Pitzul KB, Lane NE, Voruganti T, Khan AI, Innis J, Wodchis WP, Baker GR. Role of context in care transition interventions for medically complex older adults: a realist synthesis protocol. BMJ Open 2015; 5:e008686. [PMID: 26586323 PMCID: PMC4654392 DOI: 10.1136/bmjopen-2015-008686] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/21/2015] [Accepted: 09/21/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Approximately 30-50% of older adults have two or more conditions and are referred to as multimorbid or complex patients. These patients often require visits to various healthcare providers in a number of settings and are therefore susceptible to fragmented healthcare delivery while transitioning to receive care. Care transition interventions have been implemented to improve continuity of care, however, current evidence suggests that some interventions or components of interventions are only effective within certain contexts. There is therefore a need to unpack the mechanisms of how and within which contexts care transition interventions and their components are effective. Realist review is a synthesis method that explains how complex programmes work within various contexts. The purpose of this study is to explain the effect of context on the activities and mechanisms of care transition interventions in medically complex older adults using a realist review approach. METHODS AND ANALYSIS This synthesis will be guided by Pawson and colleagues' 2004 and 2005 protocols for conducting realist reviews. The underlying theories of care transition interventions were determined based on an initial literature search using relevant databases. English language peer-reviewed studies published after 1993 will be included. Several relevant databases will be searched using medical subject headings and text terms. A screening form will be piloted and titles, abstracts and full text of potentially relevant articles will be screened in duplicate. Abstracted data will include study characteristics, intervention type, contextual factors, intervention activities and underlying mechanisms. Patterns in Context-Activity-Mechanism-Outcome (CAMO) configurations will be reported. ETHICS AND DISSEMINATION Internal knowledge translation activities will occur throughout the review and existing partnerships will be leveraged to disseminate findings to frontline staff, hospital administrators and policymakers. Finalised results will be presented at local, national and international conferences, and disseminated via peer-reviewed publications in relevant journals.
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Affiliation(s)
- Kristen B Pitzul
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Natasha E Lane
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Teja Voruganti
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Anum I Khan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Jennifer Innis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
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Son KB, Kim CY. The User Fee Introduction and Its Effect in the Health System of Low and Middle Income Countries: An Exploratory Study Using Realist Review Method. HEALTH POLICY AND MANAGEMENT 2015. [DOI: 10.4332/kjhpa.2015.25.3.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Muntaner C, Ng E, Chung H, Prins SJ. Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction. SOCIAL THEORY & HEALTH 2015; 13:267-287. [PMID: 26345311 PMCID: PMC4547054 DOI: 10.1057/sth.2015.17] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Most population health researchers conceptualize social class as a set of attributes and material conditions of life of individuals. The empiricist tradition of 'class as an individual attribute' equates class to an 'observation', precluding the investigation of unobservable social mechanisms. Another consequence of this view of social class is that it cannot be conceptualized, measured, or intervened upon at the meso- or macro levels, being reduced to a personal attribute. Thus, population health disciplines marginalize rich traditions in Marxist theory whereby 'class' is understood as a 'hidden' social mechanism such as exploitation. Yet Neo-Marxist social class has been used over the last two decades in population health research as a way of understanding how health inequalities are produced. The Neo-Marxist approach views social class in terms of class relations that give persons control over productive assets and the labour power of others (property and managerial relations). We critically appraise the contribution of the Neo-Marxist approach during the last two decades and suggest realist amendments to understand class effects on the social determinants of health and health outcomes. We argue that when social class is viewed as a social causal mechanism it can inform social change to reduce health inequalities.
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Affiliation(s)
- Carles Muntaner
- Bloomberg School of Nursing, Dalla Lana School of Public Health, University of Toronto , 155 College Street, Suite 386, Toronto, Ontario, Canada M5T 1P8 ; Department of Public Health Sciences, Korea University , Suite 365, Hana Science Building, 145 Anam-Ro, Seongbuk-Gu, Seoul, 136-713 Republic of Korea . E-mail:
| | - Edwin Ng
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute , 209 Victoria Street, 3rd Floor, Toronto, Ontario, Canada M5B 1C6. E-mail:
| | - Haejoo Chung
- Department of Public Health Sciences, Korea University , Suite 365, Hana Science Building, 145 Anam-Ro, Seongbuk-Gu, Seoul, 136-713 Republic of Korea . E-mail:
| | - Seth J Prins
- Department of Epidemiology, Columbia University, Mailman School of Public Health , 722 West 168th Street, Suite #720C, New York, NY 10032, USA . E-mail:
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O'Campo P, Molnar A, Ng E, Renahy E, Mitchell C, Shankardass K, St John A, Bambra C, Muntaner C. Social welfare matters: a realist review of when, how, and why unemployment insurance impacts poverty and health. Soc Sci Med 2015; 132:88-94. [PMID: 25795992 DOI: 10.1016/j.socscimed.2015.03.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The recent global recession and concurrent rise in job loss makes unemployment insurance (UI) increasingly important to smooth patterns of consumption and keep households from experiencing extreme material poverty. In this paper, we undertake a realist review to produce a critical understanding of how and why UI policies impact on poverty and health in different welfare state contexts between 2000 and 2013. We relied on literature and expert interviews to generate an initial theory and set of propositions about how UI might alleviate poverty and mental distress. We then systematically located and synthesized peer-review studies to glean supportive or contradictory evidence for our initial propositions. Poverty and psychological distress, among unemployed and even the employed, are impacted by generosity of UI in terms of eligibility, duration and wage replacement levels. Though unemployment benefits are not intended to compensate fully for a loss of earnings, generous UI programs can moderate harmful consequences of unemployment.
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Affiliation(s)
- Patricia O'Campo
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON M5T 3M7, Canada.
| | - Agnes Molnar
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada
| | - Edwin Ng
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada
| | - Emilie Renahy
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada
| | - Christiane Mitchell
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada
| | - Ketan Shankardass
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON M5T 3M7, Canada; Department of Psychology, Wilfrid Laurier University, Sciences Building, 75 University Avenue West, Waterloo, ON N2L 3C5, Canada
| | - Alexander St John
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada
| | - Clare Bambra
- Department of Geography, Durham University IHRR326, Lower Mountjoy, South Road, Durham DH13LE, UK
| | - Carles Muntaner
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON M5T 3M7, Canada; Bloomberg Faculty of Nursing, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON M5T 3M7, Canada
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